Local Treatment

If the views previously expressed to the effect that mercury cures syphilis in consequence of the particles being brought into direct contact with the lesion, are true, it is to be expected that local treatment, when practicable, will be exceedingly useful, and play an important part in the management of the disease. These expectations are fully verified by clinical experience.

The local treatment of the chancre has already been considered. The mucous patch, whether of the genitals or of the mouth, requires local applications. The most efficient agent for this purpose is the acid nitrate of mercury. One or two applications are usually sufficient to dissipate patches of ordinary size. If this is not available, the bichloride of mercury may be employed in a plain one per cent. solution, or dissolved in collodion. Milder preparations, e.g., calomel, blackwash, etc., are less painful and less efficient. Nitrate of zinc in stick form, though not acting in a specific manner, will cause rapid disappearance of the lesion. Papular and tubercular lesions, especially about the face and other exposed parts, demand speedy removal. This may be best effected by daily frictions with ungt. hydrarg., ungt. hydrarg. ammon., or hydrarg. oleat. five per cent. In ulcerative lesions, the crusts should be removed, the ulcers well cleansed, and gently touched with liq. hydrarg. nitrat., and afterward dressed daily with the protoiodide in ointment as follows:

Hydrarg. protoiodidi................. 1. gr. xv.

Cerati............................... 30.

M.

In many oases of extensive ulceration, or of inveterate disease, the most prompt results are frequently obtained by means of mercurial fumigation, by inunction with mercurial ointment, or by hypodermic injection. One or the other of these methods is of course imperatively demanded en the administration of mercury by the mouth produces irritation of the gastro-intestinal tract.

The points that we desire to insist on in the treatment of syphilis are that mercury is, par excellence, the curative drug in syphilis, and should be used in small doses for a long continued period; that iodide of potassium 20 is not curative, but simply capable of relieving certain symptoms, which it sometimes does with wonderful promptness. That mercury probably acts by its particles being brought directly in contact with the lesions through the medium of the circulating fluid, and hence should be used locally whenever it is possible. These views were 6rst publicly urged by us in 1876 (87, 68 et seq), and were not those generally held by the pro-fession, either here or abroad, the majority of whom appear to regard the iodide as an equally important, if not more useful and less dangerous, remedy than mercury. Since then, Keyes and others in this country have announced substantially the same propositions.

Until quite recently I was not aware that Plenck,* more than a hundred years ago, had expressed himself as follows:

"Mercury alone is sufficient for destroying venereal poison. "Mercury, when topically applied to venereal parts, acts sooner and mora certainly on the poison which topically exists in that part to which it is applied.

Therefore mercury ought to be used both internally and externally at the same time.

"Mercury more especially destroys the venereal virus in the solids of our body.....

Therefore, during and after the use of mercury, other remedies are indicated, and ought to be prescribed for venereal patients, according to the variety of their symptoms."

Besides the drugs mentioned, the following may be considered:

Acid. Nitric., 9; Acid. Pyrogallic, 10; Ammonii Iodidmn, 15;

Amyli lodidum, 17; Arsenic, 25; Bignonia Caroba, 33; Calotropis, 36;

Dulcamara, 51; Hura Brasiliensis, 58; Pilocarpus, 86; Pilocarpioe

Iodohydrargyras, 87; Potassii Bichromas, 91; Sanguinaria, 102; and

Zinci lodidum, 117.